The introduction of the computerized management systems into healthcare took place over 50 years ago. Since then systems have evolved and become more intricate. They now serve many purposes that benefit patient care. It is a very large and important decision when a healthcare system must choose a specific computerized management system; from function, security, user friendliness, and cost. When this decision is made by a healthcare organization, one must take into account many aspects of this choice, which is defined as: 1.
How can the use of such computerized management system increase the quality of patient care, along with the use and integration of handheld devices? 2. Discussion of the security aspects that accompany the computerized management system; use, storage, and back up of patient information while maintaining patient confidentiality related to HIPAA (Health In formation Portability and Accountability Act). 3. The affects of the new computerized management system on healthcare costs.
Another important aspect to consider when looking and comparing new computerized management systems; is if nursing involvement in this selection process is important or beneficial. A comparison of 2 computerized management systems and each of their benefits offered to patient care and nursing care delivery are also defined below. How can the use of the computerized management systems increase the quality of patient care, along with the use and integration of handheld devices?
Computerized management systems provide many opportunities to increase the quality of patient care; one example is computerized physician order entry (CPOE). CPOE requires the physicians to enter their own orders for a patient in the computerized management system. CPOE is a huge benefit to patient safety and quality of care; this will allow for the elimination of legibility errors and incomplete orders. Another example is integration of programmed reminders and alerts. With a computerized management system, reminders and alerts can be integrated into the system.
For example the system will alert a physician to remind him to order a PTT when placing an order for a Heparin drip or a PT/INR when placing an order for Coumadin. Alerts can provide drug-drug and drug-allergy interaction checking, thus alerting the physician when he/she places and order for a medication that the patient is allergic to or has contraindications with other medication the patient is actively taking. These examples of reminders and alerts increase patient safety and quality of care.
Quality of care is also maximized with the computerized management system by health information exchange (HIE). This exchange of information will allow for a more accurate and efficient plan of care, allowing physician to see a patient’s full history, diagnosis, surgeries, ect when planning this patient’s current plan of care. HIE sharing will provide an overall view of the patient’s health, not just limiting the information to the current visit. For example a story was told by Dr. Stephen V.
Cantril that helps to explain how a 29 year-old female fell a victim of lack of HIE. This female showed up to a New York City emergency department (ED) with abdominal pain. As she explained her condition it was revealed that she recently had an appendectomy. The ED physician performed another CAT scan on this individual to find what he thought was artifact from her recent appendectomy in her abdominal CAT scan films. This led the physician to have this female stay overnight for observation, but still no further diagnosis had been made.
Dr Cantril explains that if this ED physician had access to the patients past record and CAT scan films, she may have been diagnosed properly and not released home the next day; still without answers and still in pain. This female had a rare, but easily curable complication from the appendectomy called Meckel’s diverticulum. (http://queue. acm. org/detail. cfm? id=1841832). Again proving that a lack of HIE can affect a patient’s quality of care and safety. Computerized management systems can also offer a closed loop medication administration process thus increasing a patient’s quality of care and safety.
What this means is by use of handheld barcode scanners or radio frequency identifier (RFID) tagged bracelets a patient can be properly identified along with the medication that is being administered. This verifies you have the RIGHT patient and the RIGHT medication that is order for the patient, thus significantly reducing medication errors. Another way to improve a patient’s quality of care is with the integration of handheld devices by the nursing staff. An example is the use of a PDA or tablet. Many healthcare providers are using these items today.
These items allow for increased quality of care allow the physician to access, ordering and review from almost anywhere. They also allow for real-time documentation; meaning with a PDA or tablet, a physician can be with their patient at the patients bedside placing orders and making notes on the chart, not waiting until after the examination and after talking with the patient then going to the chart and making notes and placing orders based off memory. PDA’s or tablets can also provide evidence-based decision-support by allowing access to many different resources.
This will again allow for improved quality of care for your patient. The PDA or tablet will also allow for improvement from the nursing role. Nursing will be able to perform documentation, review orders, closed-loop medication administration process, and so much more in a convenient portable hand-held device right at the patient’s bedside, without having to ever leave the room. Although nursing will still require a full desktop computer for full and complete documentation and patient care, the PDA or tablet is a quick resource for efficient, safe, quality care.
Discussion of the security aspects that accompany the computerized management system; use, storage, and back up of patient information while maintaining patient confidentiality related to HIPAA (Health In formation Portability and Accountability Act). Security standards are key when implementing a computerized management system. This is due to a standard from a regulatory agency called HIPAA (Health Information Portability and Accountability Act). First and foremost patient confidentiality must be maintained.
HIPAA helps to protect an individual’s right to control use and disclosure of his or her protected health information (PHI). PHI includes any information that is; oral, recorded, written on paper or electronic, related to a person’s mental or physical health, services provided along with billing information. With the computerized management system, the Security Rule, established by HIPAA, must be followed. The Security Rule applies to the electronic form of PHI.
The Security Rule also has 2 other goals with this electronic PHI in which the computerized management system along with the staff, must manage the integrity and availability of this information. Under the Security Rule, “integrity” is defined as, the electronic PHI is not altered or destroyed in an unauthorized manner and that “availability” means that electronic PHI is accessible and usable on demand by an authorized person only. With the computerized management system this is all possible. The Privacy Rule under.
HIPAA sets standards for (along with other things) the computerized management system and who may have access to the PHI and the computerized system will keep an electronic log of which user/person accessed the patient’s chart. As far as storage and backup the computerized system will comply with HIPAA by supplying strong back up and restoration operations. The backup copies should be created and located in a separate off-site location to prevent devastation in case of fire or a natural disaster. The affects of the new computerized management system on healthcare costs.
The computerized management system is designed to cut healthcare costs, but that may not always be the case. Yes; the computerized management system can provide evidence-based care, assist in the prevention of unnecessary duplicate testing, facilitate more informed care coordination for all patients, and create quality data in real time, but does this really cause a reduction in healthcare costs? President Barack Obama stated with a computerized management system, “This will cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests.
” Some believe an “effective EMR implementation and networking could eventually save more than $81 billion annually. ” (http://content. healthaffairs. org/content/24/5/1103. full). This belief is supported by many key points. One belief is, “Most medical records are still stored on paper, which means that they cannot be used to coordinate care, routinely measure quality, or reduce medical errors. ” (http://content. healthaffairs. org/content/24/5/1103. full). With the computerized management system, medical errors will be reduced through barcode scanning and CPOE (Computerized Physician Order Entry), thus healthcare cost savings.
Along with coordination of care and quality care measurements; again the computerized management system can provide data to improve future care and can also improve coordination of patient care thus both possibly decreasing length of stays in the hospital, decreasing healthcare costs. These are just a few of the potential saving the computerized management system can provide and aide in transforming healthcare to better our patient’s. When choosing a system to implement, nursing input is key. Nursing will be the largest user of the new computerized management system and also the biggest support system for the physicians.
Usability should be the driving factor when the choice is made. Nursing will want to use a system that will accommodate their workflow the best, without significant changes. Nursing will also be the driving factor for acceptance of the computerized system, nursing works closely with all staff in the hospital, resistance from nursing will only cause resistance from all staff. Physicians will flock to nursing staff for support, the nurses uses the system much more than the physicians. If nursing is resistant due to the feelings of an unsatisfactory system, the willingness to learn and adoption is decreased.
Cerner Millennium PowerChart and EpicCare Inpatient System are two very similar yet very different computerized management systems. Both Cerner and EpicCare promote their product to improving patient care. EpicCare allows for the integration of the ambulatory patient information and the inpatient information to reside in one place, one chart. Meaning EpicCare Ambulatory EMR can be used in both the ambulatory and inpatient setting, allowing for more complete and efficient care. Cerner’s PowerChart product is mainly for the inpatient use.
Cerner has another product called PowerChart Office that is used for the more ambulatory setting. Both of Cerner’s products are able to integrate and share information, but must be set up to do so, thus the potential for a break in the healthcare information sharing. EpicCare can actually learn your preferences while you work, it organizes patient information, suggests actions and guides coordinated care across physical care settings. Cerner allows for much of the same, allowing customization by each user, but is not able to learn your preferences as you work and suggest actions.
Both the Cerner product and the EpicCare product allow for CPOE and barcode scanning of medications increasing patient safety. They both support handheld chart access using and iPad, but EpicCare also supports and app for the physician’s cell phone to allow access to the patients’ chart anywhere. All in all most computerized systems are one in the same, but the benefits EpicCare provides; with the integration or “one chart”, combining the ambulatory and inpatient information into one database and the ability to learn your preferences and suggest actions, makes EpicCare Ambulatory EMR the number one choice.
The decision when choosing which computerized management system can be very complex. Many assessments and factors are taken in account when this decision is made. Choosing the system that is the best fit for practice and the organization will help minimize staff resistance. Technology in the healthcare field is emerging rapidly, and the future of the EMR is only known to be ever growing and expanding. The need for an integrated EMR is required.